EP2509518B1 - Surgical manipulation instrument - Google Patents

Description

The invention relates to a surgical manipulation instrument, with a coupling which connects an extracorporeal drive part with a partially intracorporeal manipulator part separable.

Surgical instruments designed not for single use but for multiple use must be sterilized after each use. The sterilization can be carried out by means of non-thermal or thermal methods. In clinical practice, sterilization is carried out essentially by thermal processes, in particular by the so-called autoclaving. During autoclaving, the instrument to be sterilized is exposed to spiked water vapor over a certain period of time, which must wet all surfaces to be sterilized. The instrument to be sterilized is exposed in the autoclave temperatures of up to 156 ° C and pressures up to 2 bar over a period of up to 40 min. Autoclaving must be repeated after each use of the instrument so that up to several hundreds of autoclaves can be performed during instrument life.

Since the 1980s, so-called minimally invasive surgery has become increasingly important. Here, long, slender manipulation instruments are advanced through only small openings in the epidermis. The intracorporeal surgical field is using a on the same way introduced rod-shaped camera and an extracorporeal monitor observed. Minimally invasive surgery offers particular advantages for the patient, namely low traumatization, short convalescence times, lower postoperative pain, lower blood loss, lower risk of infection, lower risk of wound healing disorders, better cosmetic results, etc. Disadvantages of minimally invasive surgery include the limited freedom of movement of the surgical instruments. Due to the fixed passage through the epidermal and adipose tissue, which forms an invariant point, reversed movement conditions or a disturbed hand-eye coordination result to the monitor image. Two degrees of freedom of movement are bound by the invariant point, ie not every point in the working space can be reached with any orientation of the functional instrument end.

Minimally invasive manipulation instruments, which provide additional degrees of freedom of movement within the intracorporeal system, can lead to increased intracorporeal manipulability and thus represent an important improvement for minimally invasive surgery. The additional degrees of freedom must be moved purposefully. This is possible with manual operation, but this requires great skill and practice. A robot-assisted telemanipulated approach whereby the surgeon sits away from the patient on an ergonomically-shaped console and guides the surgical manipulation instrument through the monitor using a suitable human-machine interface, without having to think about the kinematics and their actuation, is therefore meaningful. The surgical manipulation instrument is actuated computer-assisted and performs the surgeon's desired movement accordingly.

However, the actuators for driving the surgical manipulation instrument can not be autoclaved in the rule. Therefore, one is Separability of the extracorporeal drive part of the partial intracorporeal manipulator part required.

The surgical manipulation instrument is therefore separated into two parts and separable by a clutch in an extracorporeal drive part and a partial intracorporeal manipulator part.

Out US Pat. No. 6,491,707 A1 For example, a surgical manipulation instrument with a coupling for separating the drive part from the manipulator part is known. In this case, actuating elements such as shafts are rotated by the drive device and transmitted via the coupling device, the rotational and rotational movement of actuators of the manipulator. By these second actuating elements of the end effector of the manipulator part is actuated. The coupling parts each have rotatable coupling bodies, which have axial pins or bores and are coupled together axially or separated from one another. Since the rotatable opposing coupling body are not coupled together, if they are not aligned exactly with each other, a search for all coupling body pairs must be performed during engagement. The coupling bodies rotate in each case until a position is found in which all coupling body pairs are in a mergeable coupling position. A similar clutch is off US 2001 003 1983 A1 known. The coupling parts here have semi-cylindrical shaped coupling body. For a smooth coupling process, it is necessary to provide a certain minimum clearance between the coupling bodies in the coupled state. However, this game has a detrimental effect during operation of the manipulator instrument or even makes automatic regulation possibly even impossible.

In US 2008/0021278 A1 a surgical manipulation instrument is described, consisting of an actuator part and a detachable by a coupling manipulator part with end effector. In this case, the actuator part in the region of the coupling inwardly pivotable coupling arms which engage in the provided undercut lobes in the manipulator part and thus close the clutch. At the same time, the first axially movable actuating element of the actuator part is connected to the second axially movable actuating element of the manipulator part, so that a force transmission from the actuator to the end effector is possible.

Furthermore, it is off US 2009/0055409 A1 a device for dispensing liquids for minimally invasive surgery is known, which has a replaceable outlet needle. The coupling element between the liquid inlet device and outlet needle in this case comprises a plurality of coupling arms which have inwardly directed lugs at their free ends. When mating liquid inlet device and outlet needle, the coupling arms are pushed apart until they engage in the closed position in the provided undercut lobes of the liquid inlet device.

The object of the invention is to provide a surgical manipulation instrument with both the drive side and manipulator side axially displaceable elements, wherein the actuators are connected to each other by a reliable and simple coupling device.

The object is achieved according to the invention by the features of claim 1.

By means of newly developed axial movements generating drive means, it is possible not to first connected to the drive means actuators such as ropes or rods but axially, i. to move in the longitudinal direction. On the side of the manipulator part, it is also desirable to provide axially displaceable second actuating elements for actuating the end effector. The linear actuation of the end effector is advantageous in terms of handling. When using known coupling devices, it would be necessary to convert the linear movement of the first actuated by the drive means actuating elements in a rotational movement, since known coupling devices transmit rotational movements. On the side of the coupling device connected to the manipulator part, the rotational movement would then again have to be converted into an axial movement. Such a coupling device in conjunction with conversion means for converting a linear to a rotational movement, or for converting a rotational movement into a linear movement is extremely complex. A corresponding coupling device would not only be expensive and costly, but it would also be very lossy. This is not acceptable, in particular in the case of surgical manipulation instruments used in minimally invasive surgery, since a very precise transmission of forces and moments, which is as free of play as possible, must take place.

The surgical manipulation instrument according to the invention, which is particularly suitable for minimally invasive surgery, has an extracorporeal drive device and a partially intracorporeally arrangeable manipulator part. The drive device has a plurality of axially displaceable first actuators. The actuators are, for example, rods or ropes, be transmitted by the axial forces. The manipulator also has a plurality of axially displaceable second actuators, which are also for example also rods and / or ropes. The actuators serve to actuate an end effector.

The first actuating elements are connected to each other with the second actuating elements via a coupling device. About the coupling device is a releasable connection of pairs of actuators. In order to realize a detachable connection, the coupling device according to the invention has a first coupling element with an undercut bulge into which a second coupling element engages. By joining the two coupling elements is thus carried out according to a latching connection, an engagement of the second coupling element in the undercut bulge. This is preferably done by the two coupling elements are pushed axially towards each other. Here, the undercut - bulge seen in the axial direction has an undercut. The connection of the actuator pairs is thus possible by simply mating the coupling elements. This has the advantage that a connection of the drive device with the manipulator part can be done easily by hospital staff. In particular, no special knowledge is required.

According to the invention, the first coupling element is rotationally symmetrical, wherein it is preferred that the undercut bulge is annular. Accordingly, the coupling arms are arranged in a preferred embodiment on a circular ring, wherein the coupling arms surround the first coupling element when the coupling device is closed. In the embodiment of the first coupling element according to the invention as a rotationally symmetrical coupling element is in particular the advantage that the parts to be coupled can be easily connected to each other, since no orientation of the parts to each other is required.

In a preferred embodiment, the second coupling element has a plurality of pivotable coupling arms. The pivoting is preferably carried out by an elastic deformation of the coupling arms when closing the coupling device. Preferably, the coupling arms have at their free ends in particular at least partially radially arranged lugs. These approaches engage with closed coupling device in the undercut bulge. The closing of the two coupling elements thus takes place such that the two coupling elements are axially moved towards each other, wherein the first coupling element the Clutch arms of the second coupling element, for example, pushes outward or pivoted. By further mating of the coupling elements, the coupling arms are pivoted until they snap back into their starting position and engage the projections of the coupling arms in the undercut bulge.

Furthermore, it is preferred that the first coupling element is rigid and thus has a high strength. In particular, it is a solid body. As a result, a small size is possible.

In order to ensure the most secure possible connection of the two coupling elements, it is preferred that the first coupling element has a plurality of in particular axially behind one another arranged undercut bulges. These bulges, which are in a preferred embodiment in each case annular, are preferably designed such that their diameter increases in steps. The coupling arms then have according to several approaches that engage in closed coupling device in the different undercut lobes.

The first and / or the second coupling element is preferably firmly connected to the respective fastening element or also formed in one piece. As a result, the space required is reduced.

Preferably, the fixing of or holding the coupling elements of the coupling device is effected exclusively by a clamping from the outside. This allows the space to be further reduced,

In a particularly preferred embodiment, a fixing element is additionally provided. The fixing element serves to hold the coupling elements in the closed position. By fixing the unintentional opening of the coupling device is thus avoided. If the second coupling element has coupling arms which are pivoted outwardly for opening or closing, a fixing element can be provided which surrounds the coupling arms in the closed position and thus prevents pivoting of the coupling arms to the outside. Preferably, a displaceable sleeve is provided as a fixing. When the coupling device is closed, the sleeve surrounds the two coupling elements at least partially. In particular, when providing coupling arms, it is advantageous to provide an annular sleeve which surrounds the coupling arms at least in the region of the radially extending projections. To open the coupling device, it is then only necessary to move the sleeve, so that the two coupling elements can be pulled apart again, wherein, if the second coupling element has coupling arms, they are then pivoted again. Preferably, the fixing element is spring-loaded, wherein the spring load is provided such that the fixing element must be transferred against the spring force from the closed position to the open position. This ensures that an arrangement of the fixing element in the closed position by the operating personnel can not be forgotten.

In a further preferred embodiment of the invention, the second coupling element has radially displaceable holding elements such as balls or the like. By radial displacement of the holding elements in the undercut bulge occurs a closing of the coupling device. By a preferably provided fixing element is avoided that the holding elements automatically move out of the undercut bulge out. This can be done for example by the fact that the individual holding elements are spring-loaded in the direction of the undercut bulge. Also, the fixing element may be formed such that it has a recess into which the balls can be moved to release the coupling device and the fixing element for closing the coupling device is arranged such that the recess is offset from the holding elements. Here, the fixing element can in turn be designed to be displaceable.

In a preferred embodiment of the invention, the first coupling element has an axial bore into which the second coupling element or a pin-shaped projection of the second coupling element can be inserted. In this embodiment, the undercut protrusion is provided on an inner side of the bore. In the undercut bulges in turn approaches of coupling arms or retaining elements can intervene.

In a preferred embodiment, the fixing element is arranged axially displaceable within the second coupling element. Here, in this embodiment, essentially pin-like fixing element has at least one recess into which the holding elements, which are balls, can slide to open the coupling device. When moving the fixing in the closed position, the balls are pressed by the fixing in the undercut lobes, which are located in the inside of the axial bore of the first coupling element.

According to a further preferred embodiment of a surgical manipulation instrument, which represents an independent invention, the undercut bulge can also be open laterally. The opening of the undercut bulge thus has to the longitudinal axis of the corresponding actuating element at an angle of not equal to 0 °, in particular 90 °. In this development, the second coupling element has an attachment which is introduced laterally into the undercut bulge. It is particularly preferred here that all the first coupling elements have an undercut bulge whose opening points in the same direction. This makes it possible to introduce the approaches of the second coupling elements together in the undercut bulge. In particular, the second coupling elements have projections with a cylindrical cross-section, wherein the undercut protrusions are slit-like and have at their end a rounding, which substantially corresponds to the radius of the cylindrical projection. Of course, other geometric configurations are possible, wherein it is preferred that the outer shape of the second coupling elements or the lugs of the second coupling elements is complementary to the configuration of the undercut bulge.

In a further embodiment, the undercut lobes are also open at the side and in particular have an opening angle of 90 ° to the longitudinal direction of the actuating elements. The opening direction of the individual undercut bulges preferably lies on a circular line. The second coupling elements in turn have in a preferred embodiment approaches. The introduction of this particular cylindrically shaped lugs in the undercut lobes takes place here by pivoting the lugs.

The invention will be explained in more detail below with reference to preferred embodiments with reference to the accompanying drawings.

Figur 1

eine schematische, perspektivische Ansicht eines chirurgischen Manipulationsinstruments

Figur 2

eine schematische, perspektivische Seitenansicht der Antriebseinrichtung

Figur 3

eine schematische Schnittansicht eines Teils einer ersten bevorzugten Ausführungsform einer Kupplungseinrichtung

Figur 4

eine schematische Draufsicht des im Figur 2 dargestellten Bereichs der Kupplungseinrichtung,

Figur 5

eine schematische Schnittansicht einer weiteren Ausführungsform eines Teils einer Kupplungseinrichtung,

Figur 6

eine schematische, perspektivische Ansicht einer weiteren Ausführungsform einer Kupplungseinrichtung, die nicht Teil der Erfindung ist, in entkoppeltem Zustand,

Figur 7

eine schematische, perspektivische Ansicht der in Figur 6 dargestellten Kupplungseinrichtung in eingekuppeltem Zustand,

Figur 8

eine schematische, perspektivischen Ansicht einer weiteren Ausführungsform einer Kupplungseinrichtung, die nicht Teil der Erfindung ist, in entkoppeltem Zustand und

Figur 9

eine schematische, perspektivische Ansicht der in Figur 8 dargestellten Kupplungseinrichtung in eingekuppeltem Zustand.

Show it:

FIG. 1

a schematic, perspective view of a surgical manipulation instrument

FIG. 2

a schematic, perspective side view of the drive device

FIG. 3

a schematic sectional view of part of a first preferred embodiment of a coupling device

FIG. 4

a schematic plan view of the im FIG. 2 shown area of the coupling device,

FIG. 5

a schematic sectional view of another embodiment of a part of a coupling device,

FIG. 6

1 is a schematic, perspective view of another embodiment of a coupling device, which is not part of the invention, in the decoupled state,

FIG. 7

a schematic, perspective view of the in FIG. 6 illustrated coupling device in engaged state,

FIG. 8

a schematic perspective view of another embodiment of a coupling device, which is not part of the invention, in the decoupled state and

FIG. 9

a schematic, perspective view of the in FIG. 8 illustrated coupling device in engaged state.

An inventive surgical manipulation instrument, which is particularly suitable for minimally invasive surgery, has an extracorporeal drive device 10. This can in particular have one or more electric motors and transmissions, whereby actuating elements 12 (FIG. FIG. 2 ) are displaced in the axial direction (arrows 14).

These first actuating elements 12 are formed in the illustrated embodiment as rods. However, they can also be ropes, over which only tensile forces are transmitted.

Furthermore, the surgical manipulation instrument has a manipulator device 16 (FIG. FIG. 1 ) on. Within a tubular shaft 18 in turn rod-shaped second actuating elements are arranged. These are displaceable in the longitudinal direction 20. The second actuators are connected to an end effector 22. By moving the second actuating elements thus takes place an actuation of the end effector. The second actuators may in turn be bar-shaped actuators but also actuation ropes.

To connect the first actuating elements 12 and the second actuating elements arranged within the tubular shaft, a coupling device 23 is provided.

In the in the Figures 3-5 illustrated embodiments are each parts of the coupling device shown. For the sake of simplicity, in each case a first and a second actuating element are shown. Usually, both the drive device 10 and the manipulator part 16 at least two, in particular at least three such actuators. These are preferably simultaneously coupled or decoupled.

At the first in the FIGS. 3 and 4 illustrated embodiment of the invention, a first actuating element 12 and a second actuating element 24 is shown. The actuator 12 has at the end of a first coupling element 26 forming frusto-conical approach. This has in the illustrated embodiment, three each ring-shaped undercut bulges 28. Through the illustrated bulge 28 12 and 24, an undercut is realized in the axial direction or in the longitudinal direction of the actuators.

The second actuating element 24 has a second coupling element 30 on the end pointing in the direction of the first actuating element 12. The coupling element 30 comprises in the illustrated embodiment, a plurality of coupling arms 32. The coupling arms 32 have at their free end radial in the illustrated embodiment inwardly directed lugs 34. When the clutch device is closed, as in FIG. 3 is shown, the lugs 34 engage in the undercut lobes 28 a. This is possible because the coupling arms are designed to be elastic and are essentially elastically pivotable about a point 36. As a result, when the two coupling elements 26, 30 are pushed together, the coupling arms 32 are pushed outwards until the two coupling elements are in the closed position and the lugs 34 latch into the undercut recess 28.

In the illustrated embodiment, a plurality of annular undercut lobes 28 are provided. These are in FIG. 3 viewed from bottom to top each have a larger diameter and are so far stepped arranged. The first coupling element 26 as well as in the illustrated embodiment integral with the coupling element trained first actuator 12 are formed to a longitudinal axis 38 rotationally symmetrical.

The second coupling element 30 has a plurality of arranged on a circular line coupling arms 32 in the illustrated embodiment. These are in turn formed integrally with the second actuating element 24 in the illustrated embodiment. The actuating element 24 is also rotationally symmetrical to the longitudinal axis 38.

To ensure that the coupling arms 32 remain in the closed position, a fixing element 40 is provided. In the illustrated embodiment, the fixing element is a sleeve which can be displaced in the longitudinal direction 20. The sleeve 40 surrounds the two coupling elements 26,30 in the closed state of the coupling device. Since the coupling arms 32 would have to be pivoted to open the clutch to the outside, an unintentional opening of the coupling device is avoided by the sleeve 40. To open the coupling device would have the sleeve 40 in FIG. 3 be moved up. In this position, the two coupling elements 26,30 then be pulled apart in the axial direction. Since usually two or more actuating element pairs 12-24 are connected to each other in particular at the same time, it is preferred that the sleeves 40 are displaceable relative to one another during operation, but are stationary relative to the drive elements 12-24.

It is also possible that the first coupling element, for example, spherical and is firmly connected to the first actuator 12. Also in such a ball an undercut bulge is formed in the corresponding radial projections of coupling arms can engage.

At the further in FIG. 5 illustrated embodiment of the invention, identical components are identified by the same reference numerals.

In this embodiment, the first coupling element 26 is again formed rotationally symmetrical to the longitudinal axis 38. The substantially cylindrically shaped first coupling element 26 has a central, centrally extending bore 42 in the axial direction. On an inner side 44 of the bore 42 which in turn is formed annular undercut bulge 28 is arranged.

The second coupling element 30 is rod-shaped in the illustrated embodiment and for closing the coupling device as in FIG. 5 shown inserted into the axial bore 42. The second coupling element 30 also has a central bore 46 extending in the axial direction. In this a rod-shaped in this embodiment, fixing element 48 is arranged, wherein the rod-shaped fixing element 48 is always pressed by a spring 50 in the direction of the first actuating element 12. In this position are in the illustrated embodiment designed as balls holding elements 52 on the smooth, cylindrical outer surface of the fixing element 48 at. This causes the balls 52 in FIG. 5 pressed radially outward into the undercut bulge 28. As a result, the coupling element is in a closed position. Due to the spring load of the fixing element 48, an automatic unintentional opening is avoided. To open the coupling device, it is necessary to move the fixing element 48 in the direction of an arrow 54, ie in the direction of the second actuating element 24. This can be done for example via a pin-shaped approach, not shown, which is guided through a slot-shaped opening in the coupling element 30 to the outside. By shifting this approach, then also a displacement of the fixing element 48. As in this embodiment, preferably at least two pairs of actuating elements 12-24 are again provided, it is again preferred that the fixing elements 48 are actuated together.

By moving the fixing member 48 in the direction of arrow 54, a displacement of the recess 56 at the level of the balls 52. This makes it possible to extract the second actuator 24 from the axial bore 52, since the balls 52 are radially inwardly displaceable.

Of course, it is also possible to combine the two embodiments described above with each other, in particular individual actuator pairs as described Figure 3.4 and others like that FIG. 5 paired described described with each other.

In a further embodiment ( FIG. 6 and 7 ) is an independent invention of the coupling device. The coupling device also serves for connecting first actuating devices 12, which are rods in the illustrated embodiment, with second actuating devices 24, which are likewise rod-shaped actuating devices. The actuating devices 12, 24 are, as explained on the basis of the embodiments described above, with a drive device 10 (FIG. FIG. 1 ) or an end effector 22.

First coupling elements 26 are connected to the second actuating devices 24 for configuring the coupling device 23. These each have an undercut bulge 28. In the illustrated embodiment, all undercut lobes 28 in the same direction. Furthermore, the undercut lobes 28 to the longitudinal axes of the second actuating means 24 at an angle of 90 °, so that the undercut lobes 28 are laterally open.

The first coupling elements 30 connected to the first actuating devices 12 have a cylindrical pin 60 in the illustrated embodiment. The two in FIG. 6 front pin 60 point in the opposite direction. To a common insertion of the pin 60th into the undercut lobes 28, the pin 62 of the rear actuating element 12 protrudes in both directions and engages in the two parts 28 of the rear undercut bulge. The pin 62 is passed during insertion into the divided undercut bulge 28 between the two first coupling elements 26.

In imported condition ( FIG. 7 ) can be transmitted from the first actuating means 12 axial forces in the direction of an arrow 64, ie in the direction of the longitudinal axes of the first actuating means 12, to the second actuating means 24.

In a further embodiment of a further coupling device 23, which is also an independent invention ( FIG. 8 and 9 ), it is one of the in the FIGS. 6 and 7 illustrated embodiment similar embodiment. The essential difference is that the engagement by jointly rotating the first actuating elements 12 in the direction of an arrow 66 ( FIG. 8 ) he follows. Accordingly, the undercut lobes 28 of the second coupling elements 26 are arranged on a circular line and open in the tangential direction. In this exemplary embodiment with three first actuating devices 12, these each have radially outwardly extending cylindrical projections 60. These have angles of 90 ° relative to the longitudinal axis of the respective first actuating devices. One behind the other, the pins have an angle of 120 °. The three actuating elements 12 including the first coupling elements 30 are identical in this embodiment. This also applies to the second actuating element 24 in conjunction with the first coupling elements 26.

Claims (12)

1. A surgical manipulation instrument, in particular for minimally invasive surgery, comprising:

   an extra-corporeal drive device (10) comprising a plurality of axially displaceable first actuation elements (12),

   a partially intra-corporeal manipulator part (16) comprising a plurality of axially displaceable second actuation means (24) for actuating an end effector (22), and

   a coupling device (23) for a detachable coupling of a respective actuation elements pair (12, 24), said coupling device (23) comprising a first coupling element (26) with an undercut recess (28) into which a second coupling element (30) engages,

   characterized in that

   the first coupling element (26) is rotationally symmetric in particular with respect to its longitudinal axis (38) that coincides with the longitudinal axis of the first actuation element (12).
2. The surgical manipulation instrument of claim 1, characterized in that the second coupling element (30) comprises pivotable coupling arms (32) having their free end provided with a projection (34), in particular a radially arranged projection, which engages into the undercut recess (28) when the coupling device is in the closed state.
3. The surgical manipulation instrument of claim 2, characterized in that the coupling arms (32) are arranged on a circular ring and surround the first coupling element (26) when the coupling device is in the closed state.
4. The surgical manipulation instrument of one of claims 1-3, characterized in that the undercut recess (28) is annular in shape.
5. The surgical manipulation instrument of one of claims 1-4, characterized in that the first coupling element (26) comprises a plurality of undercut recesses (28) arranged in particular one after the other in the axial direction.
6. The surgical manipulation instrument of claim 4 or 5, characterized in that the diameter of the annularly shaped undercut recesses (28) increases step-wise in the axial direction.
7. The surgical manipulation instrument of one of claims 1-6, characterized in that the first and/or the second coupling element (26, 30) is rigidly connected, in particular formed integrally, with the first or the second actuation element (12, 24), respectively.
8. The surgical manipulation instrument of one of claims 1-7, characterized by a fixing element (40, 48) for holding the coupling elements (26, 30) in the closed position in order to prevent the coupling device (23) from being opened.
9. The surgical manipulation instrument of claim 8,'characterized in that the fixing element (40) at least partly surrounds the coupling elements (26, 30) in the closed position, the fixing element (40) preferably comprising an axially displaceable sleeve.
10. The surgical manipulation instrument of one of claims 1-9, characterized in that the second coupling element (30) comprises holding elements (52), adapted to be displaced radially into the undercut recess (28), for closing the coupling device (23).
11. The surgical manipulation instrument of one of claims 1-10, characterized in that the first coupling element (26) comprises an axial bore (42) into which the second coupling element (30) may be inserted, the undercut recess (28) being provided on an inner side (44) of the bore (42).
12. The surgical manipulation instrument of claim 10 or 11, characterized in that, in the closed position, the axially displaceable fixing element (48) presses the holding elements (52) radially outward and comprises a recess (56) into which the holding elements (52) slide for opening.

Images